Health (SDG3 and beyond)

Investment Needs for Achieving the Sustainable Development Goals in Asia and

the Pacific, November 14-15, Bangkok

Karin StenbergHealth Systems Governance and

Financing,

WHO

http://www.who.int/en/news-room/detail/17-07-2017-who-estimates-cost-of-reaching-global-health-targets-by-2030

Framework: Limiting the scope to activities where Health is the Primary Intent

Recognising important links with other SDGs

Analytical framework

Requires Targeted Investments in Health System and Best Buys

Methods• 67 Low- and middle income countries with greatest needs (=95% of

pop in L&MICs)

• Interventions, targets and activity costs based on global norms/benchmarks and taking into account pre-existing global strategies and guidelines (incl. UNAIDS Fast-Track, StopTB Global Plan 2016-2020, Global Malaria strategy 2016–2030, etc)

• Projected additional cost and impact. Using country-specific disease burden, health system data and prices.

• Using tools, methods and databases that have been peer-reviewed and published: OneHealth Tool, Spectrum impact models (incl. AIM, GOALS), WHO-CHOICE price database

• Integrated model for projected health impact in OneHealth Tool.

• Shared systems-wide investments (e.g., health workforce, infrastructure) considered from a UHC perspective

• Two scenarios: Ambitious (aligned with global targets), and Progress (less ambitious targets)

• Consultative process – joint review with global experts and country participants from 14 large countries

AP region:

19 countries, 68% population

Advancing towards benchmarks for SDG attainment

Health goal: 13 targets; many indicatorsWhile health systems vary; global benchmarks indicate investment needs

Health workforce: 4.45 doctors, nurses and midwives and 2.15 “other” health workers per 1000 people, with an additional 2 “other” workers per 1000 rural population. *

Health infrastructure: 1 urban health center per 12,000 people, 1 rural health center per 6,000 people, 1 urban district hospital per 100,000 people, 1 rural district hospital per 50,000 people, and 1 provincial hospital per 1 million people.

Emergency Risk Management: benchmarks for laboratory density, hazard pay, core capacities of the International Health Regulations etc.

“Others” refers to the other cadres of health workers in the WHO Global Health Workforce Statistics database, which include, dentists, pharmacists, laboratory health workers, community and traditional health workers, and health management and support health workers.

Stenberg K, Hanssen O, Edejer TT, et al. Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries. The Lancet Global health 2017; 5(9): e875-e87.

• Global standards and benchmarks applicable for all countries

• To identify countries with specific needs (e.g., conflict affected states need international humanitarian support and reconstruction in initial years).

• To determine capacity for scale-up curve, related to speed at which additional resources can be injected in the health system

Type Number Description

Conflict-affected states

4 Countries with an internal or external conflict which considerably limits the state’s ability to provide health services

Vulnerablesystems

11 Countries with limited ability to rapidly scale up health service delivery, due to past distress, isolated emergencies or conflicts that have interrupted and may prohibit future improvements of the public health sector.

HSS 1 15 These countries require an engineering of their health system in order to build the foundations of strong health system institutions, and will thus require significant investments across the health system.

HSS 2 16 Countries have invested in the foundation but grapple with issues around efficiency, and access. There is increasing focus on reaching the poor, and increasing citizen’s voice for service quality, accountability mechanisms.

HSS 3 21 Countries with mature health systems but in which there is an ongoing need to support health system transformation and reorienting models.

Country Typology

Pathways to SDG and ability to scale up depend on country circumstances

* Stylised curves used in the modelling. Starting coverage is country specific.

an additional

Projected additional per capita need for AP countries, years 2020 and 2030

Analysis for 19 AP countries indicates that on average

4.7% of GDP needs to be spent on health 2016-2030

(by 2030 range is 2-10% in ambitious GDP growth

scenario).Note this does not include all anticipated developments in health sector. Moreover GDP growth assumptions are likely overly optimistic. The actual value would thus be higher.

Modelled Significant Additional

Life Expectancy Gains by 2030(limited set of sample countries)

Projected Additional gains in Healthy Life Years(67 low and middle income countries)

Health spending efficiency: we modelled an efficient system using a global standard. Efficiency analysis should be addressed through country specific analysis. Cost-effectiveness varies between regions/countries depending on disease burden and health system.

Best buys for health: are there key areas where health gains may be highest compared to the financial cost?

Yes, but:…The issue of short-term vs long-term gains. …The need to invest in the overall system for equitable access to quality care….Issues around equity and out of pocket/financial catastrophic expenditure.Decisions to be made at country level.

Supporting country-led analysis for national health strategic plans

The OneHealth Tool – a joint UN tool to assess health system, costs and project impact

Used in >40 countries to date(e.g., Bangladesh, Cambodia, Nepal, Sri Lanka)

0

2,000

4,000

6,000

8,000

10,000

12,000

20112012

20132014

20152016

20172018

20192020

Nur

ses,

FTE

's

Nurses available

FTE's neededBurkina 50

FTE's neededBurkina 70

FTE's neededBurkina 90

Facilitating scenario analysis

Projecting overarching health indicator: HLE

Linking cost with impact (lives saved, etc): making the case for investment

Additional analysis on labor market productivity and economic growth outcomes

Acknowledgements for global health SDG price tag

Work undertaken by WHO. Analysis coordinated by WHO/HGF team on Economic Analysis and Evaluation, in collaboration with partners (USAID/Deliver, StopTB, UNAIDS)

Data shared by Gabriela B Gomez ( Amsterdam Institute for Global Health and Development), Anna Vassall (London School of Hygiene & Tropical Medicine), Carel Pretorius (Avenir Health), and Suvanand Sahu (StopTB), Jose Antonio Izazola (UNAIDS) , Guy Hutton (UNICEF).

Guidance for specific components in analysis provided by Ignacio Astorga (Inter-American Development Bank), Egbert Sondorp (The Royal Tropical Institute [KIT]), Annemarie ter Veen (KIT), Luis Buscarons (Inter-American Development Bank), Julie Fisher (Georgetown University), Tim Amukele (Johns Hopkins University), Lee Schroeder (University of Michigan); Marie Tien, Andrew Inglis, and Brian Serumaga, all of John Snow Inc and USAID’s Deliver Project.

The Country and Technical Review Group contributing to the validation process through their participation in a meeting to review the proposed methods and first round of estimates.